Your personal details. Please review them and make any necessary adjustments.
In the following sections, please select whichever applies. Your answers are for our records only and will be kept confidential in accordance with applicable laws. During your initial visit, you may be asked questions about your responses to this questionnaire, and additional questions concerning your health may be requested.
Dental professionals primarily treat the area in and around your mouth, but since your mouth is part of your body, any medication you are taking, and your health history have an important relationship with your dental treatment. Please answer the following questions:
Please, go over the following section and indicate which of the following you have or have had.
Your coverage details. Please review them and make any necessary adjustments.
PATIENT CONSENT FORM: FOR COLLECTION, USE AND DISCLOSURE OF PERSONAL INFORMATION.
CANADA ANTI-SPAM LEGISLATION (CASL)
AUTHORIZATION FOR EMAIL AND TEXT COMMUNICATION